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(Chest. 2006;130:1003-1008.)
© 2006 American College of Chest Physicians

The Effect of 1 Week of Continuous Positive Airway Pressure Treatment in Obstructive Sleep Apnea Patients With Concomitant Gastroesophageal Reflux*

Maroun Tawk, MD, FCCP; Suanne Goodrich, PhD; Gary Kinasewitz, MD, FCCP and William Orr, PhD

* From Pulmonary and Critical Care Medicine (Drs. Tawk and Kinasewitz), University of Oklahoma Health Sciences Center; and Lynn Institute Sleep Laboratory (Drs. Goodrich and Orr), Lynn Health Science Institute, Oklahoma City, OK.

Correspondence to: Maroun M. Tawk, MD, FCCP, 920 Stanton L. Young Blvd, WP 1310, Oklahoma City, OK 73104; e-mail: Maroun-tawk{at}ouhsc.edu

Abstract

Study objectives: Patients with obstructive sleep apnea (OSA) have a very high incidence of gastroesophageal reflux (GER). Previous studies have shown that the use of continuous positive airway pressure (CPAP) reduces the frequency of reflux events, but these studies only assessed the effect of a single night of treatment. The aim of this study was to assess the effect of 1 week of CPAP treatment on reflux in patients with OSA and GER.

Design: Sixteen patients with OSA and GER were recruited. Polysomnography followed by 24-h, continuous esophageal pH monitoring were performed at baseline. Patients with an apnea-hypopnea index (AHI) > 20/h and 24-h acid contact time (ACT) of at least 6% were included. As part of the polysomnography-qualifying evaluation, all patients underwent CPAP titration to reduce the AHI to < 10/h. Patients were then sent home receiving nasal CPAP for 1 week; after 1 week, esophageal pH monitoring was repeated while receiving CPAP.

Measurements and results: The AHI fell from 63.3 ± 38.5 to 3.2 ± 2.2/h (mean ± SD) [p < 0.001]. Total ACT fell from 13.9 ± 11.6 to 5.6 ± 2.7% (p < 0.001). The upright ACT was reduced from 12.4 ± 6.8 to 6.8 ± 3.8% (p = 0.01), and the supine (during the sleeping interval) ACT was reduced from 16.3 ± 18.8 to 3.8 ± 7.6% (p < 0.01). Eighty-one percent of the patients had a reduction in supine ACT to within the normal range (< 4%).

Conclusions: In OSA patients with significant heartburn complaints, CPAP would appear to be an efficacious approach to the treatment of both disorders.

Key Words: continuous positive airway pressure • gastroesophageal reflux disease • obstructive sleep apnea






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